HomeMy WebLinkAboutApp-Permit-ComplianceNo.L1 4.`�Z� Fxx.. 1!_ 00 _ »_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.................. Town ---........... O F .................... Yarmouth ................................................
1.
Applitatinn for Disposal Works Tonsirurtinn Patti#
Application is hereby made for a Permit to Construct
System at: t-0-1 P) q
. 12.»&..14_Dol n_ Way,---- .....k nt�1? . 1al ..............
Location - Address
Davenyort» Realty,».......................................................
»» .•.»_•» Owner
_»John E. Pina
Installer
Type of Building
Dwelling — No.
Other —Type i
or Repair (X) an Individual Sewage Disposal
...»so.: Yarlllou is.. _._._»92 64 .....................
or Lot No.
-•--So ... Yarmouth,_, MA 02664 .................. »».... ».....-
Address
__, 37 Obed Brooks»Road,._ Harzichx__MA_________________
.
Address
Size Lot .... 12 930 ......... Sq. feet
of Bedrooms ................ 4 .......................... Expansion Attic ( ) Garbage Grinder ( )
E Building ..� IeX........... No. of persons ............................ Showers ( ) — Cafeteria ( )
Otherfixtures...................................•---:....---•--.........---------...........---- .................---•-
Design Flow............................................gallons per person per day. Total daily flow ............................................ gallons.
Septic Tank — Liquid' ca.pacity............gallons Length ................ Width ................ Diameter................ Depth ................
Disposal Trench — No ..................... Width .................... Total Length .................... Total leaching area ...................sq. ft.
Seepage Pit No ..................... Diameter.................... Depth below inlet.................... Total leaching area .................sq. ft.
Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date ........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water:.......................
Description of Soil
-----------------------------------------------------------------------------------------------------------------------------------•------------------•••.............-•----.._.._._..._................
Nature of Repairs or Alterations — Answer when applicable.......................................................................... ...-_.....
Add stone lined H2O leach pit, -_from existing D–Box_.__-t__�.Y_S � _-5� ��---- .......
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of T I T IS 5 of the State Sanitary Code — Th signed further agrees not to place the system in
operation until a Certificate of Compliance has ee is d th oard of health.
Signed .. `-------------------------------------SQe_ /a,.
a ..19189
ApplicationApproved By--• - -- -------------------•----•---•--......-----------•----.......---........---...... �_...<.�� ----
Application Disapproved for
Permit No........ ..!_......5___.2. ........
i��E�COMM NWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............: ` ....-.. .:.. . O F...1.. t-.� /1.. .............................
�F t tair 1f Toutplinurr
THIS IS TO C A?TIFY,
by..................... 2 t r -
Sewage Disposal System constructed
) or Repaired " \
I} �7 1 % 11
Installer
at ................. i.C..a`r . ..•••.. l : �✓ � Y1 ( 1�� - ��-
has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No ------ _-__�� .�-------: dated.... 7 ..............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION AATISFACTORY. /
»..::............».�� ............ Inspector.. ......................... / ' 1 `-:�:'•::'